Purpose: CTA was introduced and efficiently utilized in the evaluation of patients with acute stroke in Lithuania. Our aim was to determine scientific and clinical value of intracranial CTA in detecting the anatomical variants and pathological changes of Circle of Willis (CW) arteries in patients with acute stroke.
Methods and Materials: Study was conducted prospectively between the years 1997-2002 in Vilnius University Emergency hospital. 114 patients with acute stroke (median age 58 years, male/female 64/50) and 122 controls median age 43 years, male/female 70/52) were examined. We used Siemens Somatom Balance Spiral CT Scanner. Acquisition parameters: collimation - 2mm, table speed - 3mm/sec, reconstruction interval - 1mm, rotation time - 1sec. IV contrast volume 90ml with injection rate 3,5ml/sec, delay 18sec. We routinely examined axial images as well as 3D reconstructions using MIP and SSD techniques and obtained optimal images of the main intracranial arteries. We compared pathological changes of the arteries in patients with and without visible brain damage.
Results: Patent CW was found only in 11/114 (9,7%) of patients and in 19/122 (14,4%) of controls. Anomalous CW was found in 31/114 (27,2%) of the patients and in 22/122 (16,7%) controls (p<0,045). Hypoplastic Vertebral artery was observed in 54/114 (47,8%) of patients and 45/122 (34,1%) in controls (p<0,034). We observed double hypoplastic arteries: 65 (57,2%) in patients and 56 (42,4%) in controls (p<0,022). Brain infarction was found on CT in 42 cases. We found a statistically significant correlation between severity of abnormalities in Basilar and Posterior Cerebral arteries and the extent of brain damage in vertebrobasilar region (p<0,001). The anomalous CW and its variants did not significantly influence the severity of stroke. The collaterals were visualized more often in patients with severe disease of Basilar and Posterior Cerebral arteries and absent Posterior Communicating artery (p<0,05).
Conclusion: CTA allows accurate assessment of anatomical variants and pathological changes of intracranial arteries in patients with acute stroke. The collateral status as assessed by CTA seems to be a reliable predictive factor for the possible brain damage.
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